- 期刊
False Negative Bone Scan in a Prostate Adenocarcinoma Patient With Diffuse Osteolytic Bone Metastases
偽陰性骨骼掃描表現於一位前列腺癌病人合併瀰漫性溶骨性骨轉移
摘要
A bone scan is typically used as a routine primary staging test for prostate cancer to detect bone metastases. However, a bone scan using Tc-99m methylene diphosphonate (Tc-99m MDP) is an indirect method to detect bone metastases. We presented a case in which the bone scan completely missed diffuse osteolytic bone metastases in a patient with prostate adenocarcinoma. A 68-year- old male visited our Orthopedics outpatient department due to low back pain lasting for 10 days. A magnetic resonance imaging of the lumbar spine revealed multifocal bone marrow signal changes in the thoracolumbar, sacral spine, and pelvic bones. Prostatic adenocarcinoma was diagnosed by bone marrow aspiration, with a serum prostate-specific antigen level of 3,573 ng/mL. Computed tomography images showed diffused bony metastases in the spine and rib fractures. However, the bone scan of this patient only suggested degenerative spine disease and post-traumatic responses at the ribs. Our case demonstrates a significant discrepancy between diffuse bone metastases involvement and a negative bone scan image. We should raise awareness of false-negative bone scans in patients with a high risk of advanced prostate cancer, especially in the presence of pure osteolytic bone metastasis.
並列摘要
全身骨骼掃描常被用作前列腺癌的常規分期檢查以檢測骨轉移。然而，使用Tc-99m methylene diphosphonate的骨骼掃描實際上是一種間接的偵測方法。我們將分享一個前列腺癌患者的瀰漫性脊柱溶骨性骨轉移完全被全身骨骼掃描遺漏的案例。一位68歲的男性因腰痛十天來到我們醫院的骨科門診求醫。腰椎核磁共振顯示胸、腰、薦椎及骨盆骨多灶性骨髓信號改變、多處淋巴結腫大。透過骨髓穿刺診斷為前列腺癌，血液攝護腺特異抗原prostate-specific antigen為3,573 ng/mL。電腦斷層影像顯示多處脊柱骨轉移和肋骨骨折。然而，該患者的骨掃描僅顯示退化性脊柱疾病和肋骨創傷後反應。此病例展示了瀰漫性骨轉移與全身骨骼掃描圖像之間存在的很大的不一致。因此我們應該提高對晚期前列腺癌或骨轉移的高風險患者出現全身骨骼掃描偽陰性的注意，特別是存在純溶骨性骨轉移的情況。